MEDICARE: SUDHA PATEL MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	129033	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0143156	OTHER	NY	GHI

General Provider Information

NPI Number	:	1851568091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUDHA PATEL MD PLLC

Provider Business Mailing Address
First Line	:	1835 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5706
Country	:	US
Telephone Number	:	718-236-6025
Fax Number	:	718-236-6391

Provider Business Practice Location Address
First Line	:	1835 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5706
Country	:	US
Telephone Number	:	718-236-6025
Fax Number	:	718-236-6391

Authorized Official
Title or Position	:	OWNER
Name	:	MISS SUDHA P PATEL
Credential	:
Telephone Number	:	718-236-6025

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	10/07/2008

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